胆汁酸谱与生物制剂治疗克罗恩病早期疗效的关系  

Relationship between bile acid profile and early efficacy of biological agents in Crohn's disease

作　　者：陈锋[1] 丁进 王群英 郭茂东 胡益冰 Chen Feng;Ding Jin;Wang Qunying;Guo Maodong;Hu Yibing(School of Medicine,Shaoxing University,Shaoxing 312000,China;Department of Gastroenterology,Jinhua Municipal Central Hospital of Zhejiang Province,Shaoxing University,Jinhua 321000,China)

机构地区：[1]绍兴文理学院医学院,绍兴312000 [2]绍兴文理学院浙江省金华市中心医院消化内科,金华321000

出　　处：《中华炎性肠病杂志(中英文)》2025年第1期74-79,共6页Chinese Journal of Inflammatory Bowel Diseases

基　　金：金华市中心医院中青年科研启动基金(JY2022-0-04)。

摘　　要：目的探讨胆汁酸谱与生物制剂治疗克罗恩病(CD)早期疗效的相关性。方法回顾性纳入2021年1月至2024年3月于金华市中心医院门诊及住院使用生物制剂(乌司奴单克隆抗体、维得利珠单克隆抗体单用或联合治疗)诱导治疗的活动期CD患者。收集患者治疗前的临床资料及血清胆汁酸谱。诱导治疗结束后, 依据CD活动指数(CDAI)评分将CD患者分为缓解组和未缓解组。比较两组CD患者生物制剂诱导治疗前的临床资料, 分析胆汁酸谱与生物制剂早期疗效的关系。结果纳入CD患者100例, 其中缓解组74例, 未缓解组26例。单因素分析显示, 缓解组患者的血红蛋白[137(119, 147)g/L比121(109, 136)g/L, P = 0.027]、红细胞压积[(0.40 ± 0.06)%比(0.38 ± 0.05)%, P = 0.030]、总胆汁酸[3.8(2.4, 6.1)μmol/L比2.0(1.5, 2.7)μmol/L, P < 0.001]、胆酸[0.188(0.059, 0.597)μmol/L比0.055(0.024, 0.111)μmol/L, P < 0.001]、鹅脱氧胆酸[0.812(0.268, 1.717)μmol/L比0.308(0.087, 0.552)μmol/L, P < 0.001]、脱氧胆酸[0.042(0.001, 0.299)μmol/L比0.002(0.001, 0.159)μmol/L, P = 0.028]高于未缓解组。此外, 缓解组的治疗前内镜评分(SES-CD)[4.0(0, 6.0)分比6.0(3.0, 10.5)分, P = 0.025]、红细胞沉降率(ESR)[9.0(2.8, 20.0)mm/1 h比28.0(12.8, 40.8)mm/1 h, P < 0.001]和C反应蛋白[0.6(0.2, 6.7)mg/L比9.1(1.5, 23.9)mg/L, P < 0.001]低于未缓解组。多因素Logistic回归分析结果显示鹅脱氧胆酸(OR = 3.317, 95%CI:1.270~12.437;P =0.041)和ESR(OR=0.979, 95%CI:0.957 ~ 0.997;P =0.034)是影响生物制剂治疗CD早期疗效的独立影响因素。结论鹅脱氧胆酸是生物制剂治疗CD早期疗效的独立影响因素。Objective To explore the correlation between bile acid profiles and early efficacy of biologics for Crohn's disease(CD).Methods Patients with active CD who were treated with induction therapy with biologics(ustekinumab,vedolizumab,or combination therapy)in outpatient and inpatient clinics from January 2021 to March 2024 in Jinhua Central Hospital were included.Clinical data and serum bile acid profile of patients before treatment were collected.At the end of induction therapy,CD patients were categorized into remission and non-remission groups based on the CD activity index(CDAI)scores.Compare the clinical data of the two groups of patients with CD before induction treatment with biological agents,retrospective analysis of bile acid profiles in relation to early efficacy of biologics.Results A total of 100 patients with CD were included,including 74 patients in remission group and 26 patients in non-remission group.Univariate analysis showed that hemoglobin[137(119,147)g/L vs.121(109,136)g/L,P=0.027],erythrocyte pressure volume[(0.40±0.06)%vs.(0.38±0.05)%,P=0.030],total bile acids[3.8(2.4,6.1)μmol/L比2.0(1.5,2.7)μmol/L,P<0.001],cholic acid[0.188(0.059,0.597)μmol/L vs.0.055(0.024,0.111)μmol/L,P<0.001],chenodeoxycholic acid[0.812(0.268,1.717)μmol/L vs.0.308(0.087,0.552)μmol/L,P<0.001],and deoxycholic acid[0.042(0.001,0.299)μmol/L vs.0.002(0.001,0.159)μmol/L,P=0.028]were signficantly higher in remission group than those in unremission group.In addition,the pretreatment endoscopic score(SESCD)[4.0(0,6.0)vs.6.0(3.0,10.5),P=0.025],erythrocyte sedimentation rate(ESR)[9.0(2.8,20.0)mm/1 h vs.28.0(12.8,40.8)mm/1 h,P<0.001]and C reactive protein(CRP)[0.6(0.2,6.7)mg/L vs.9.1(1.5,23.9)mg/L,P<0.001]in the remission group were lower than those in the non-remission group.Multirariate logistic regression analysis showed that chenodeoxycholic acid(OR=3.317,95%CI:1.270-12.437;P=0.041)and ESR(OR=0.979,95%CI:0.957-0.997;P=0.034)were the independent influencing affecting the efficacy of biologics for the treatment of Crohn'

关 键 词：克罗恩病 胆汁酸谱 生物制剂 

分 类 号：R574.62[医药卫生—消化系统]